Derma

Keratoacanthoma Centrifugum Marginatum (KCM) after photodynamic therapy with good response to oral retinoids and topical 5‐fluorouracil
E Silva  A Estébanez  JM Martín  C Monteagudo  E Montesinos
First published: 07 June 2019 https://doi.org/10.1111/dth.12988
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12988.
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ABSTRACT
Keratoacanthoma centrifugum marginatum (KCM) is a rare variant of keratoacanthoma (KA), characterized by progressive peripheral growth, and usually devoid of deep invasion. Different systemic (oral retinoids) or topical treatments have been reported, but there is not a well‐defined therapeutic protocol. We report the case of a KCM developing after photodynamic therapy (PDT) on the right leg of a 64‐year‐old woman. It was treated successfully with oral acitretin combined with topical 5‐Fluorouracil + salicylic acid for 5 months. This is the first case of KCM developing after PDT and successfully treated with oral retinoid combined with topical treatment.

The Effect of Platelet Rich Plasma on Hair Re‐growth in Patients with Alopecia Areata Totalis: a Clinical Pilot Study
Faezeh Khademi MD  Zohreh Tehranchinia MD  Fahimeh Abdollahimajd MD  Shima Younespour Ph.D  Seyyed Mohammad Reza Kazemi‐Bajestani MD  Kambiz Taheri MD
First published: 07 June 2019 https://doi.org/10.1111/dth.12989
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12989.
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Abstract
Background
Autologous platelet rich plasma (PRP) is blood plasma with enhanced concentration of platelets and is enriched with several growth factors which stimulate tissue regeneration. The current study aimed to investigate the effect of PRP on hair regrowth in patients with alopecia areata (AA) totalis.

Methods
Ten subjects (28.9±6.28 years; 5 males and 5 females) with clinically diagnosed AA totalis for at least 3 years who had not received any treatment within three months prior to the study were recruited. Blood sample was collected in thrombocyte harvesting tubes. The PRP was separated via centrifugation. The patients' scalp was divided sagittally into two approximately equal parts. In each patient, 4 ml PRP was injected intradermally into the left or right side of the scalp, in each point, 0.1 ml PRP was injected. Each patient was followed‐up monthly for four months.

Results
No hair regrowth was seen in 8 patients and in two patients only <10% hair re‐growth was observed. Totally no significant effect was found for PRP on hair regrowth (p>0.05). There was no side effect during treatment.

Conclusion
Single dermal PRP injection did not prove to have any effect on hair regrowth in these patients.

CLAPO SYNDROME: EFFECTIVE RESPONSE TO TREATMENT WITH ORAL RAPAMYCIN
María Rosario González‐Hermosa MD, PhD  Eneritz Guerra MD  Iñigo Tuduri MD  Iris Vicente MD Ricardo López‐Almaraz MD
First published: 07 June 2019 https://doi.org/10.1111/dth.12991
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12991.
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Abstract
CLAPO syndrome (Capillary vascular malformation of the lower lip, Lymphatic malformations of the head and neck, Asymmetry and Partial or generalized Overgrowth) is a non‐frequent pathology. This syndrome is characterized by the capillary malformation (CM) of the lower lip, a very important clinical sign when diagnosing CLAPO. The aim of our report is to demonstrate that rapamycin could be a reliable and safe targeted therapy in lymphatic malformations (LMs). This drug is useful in reducing the LM's size before final surgical treatment. The clinical and radiological evolution of a patient with CLAPO syndrome is reported in this article, before and after the treatment with rapamycin.

Effects of CO2 Fractional Laser Therapy on Peripheral Blood Cytokines in Patients with Vitiligo
Yongxuan Hu MD  Xinyu Qi BM  Yanqing Hu BM  Yan Lu BM  Kangxing Liu BM  Xue Han MM  Zuhao Mao MM  Zhong Wu BM  Xianyi Zhou MM
First published: 07 June 2019 https://doi.org/10.1111/dth.12992
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12992.
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Abstract
Vitiligo is a disease pathologically characterized by specific damage to melanocytes. The aim of this study was to explore the mechanism underlying CO2 fractional laser treatment of vitiligo by detecting the levels of Th1 cytokines (IL‐2 and IFN‐γ), Th2 cytokines (IL‐4 and IL‐10), and Th17 cytokines (IL‐17 and IL‐23) in peripheral blood. Twenty‐five vitiligo patients were enrolled in this study and were treated with a CO2 fractional laser 4‐8 times. The cytokines of 25 vitiligo patients and 20 healthy volunteers were measured by ELISA. After CO2 fractional laser therapy, 6 cases were cured, and the apparent efficiency was 72.0% (18/25), while the efficiency was 92.0% (23/25). Before CO2 fractional laser therapy, IL‐2 and IFN‐γ levels in vitiligo patients were higher than those in the control group, but the difference was not statistically significant (P>0.05). IL‐4, IL‐10, IL‐17, and IL‐23 levels were also higher in vitiligo patients than those in the control group (P<0.05). After treatment, IL‐2 and IFN‐γ levels in vitiligo patients were lower than before treatment, but the difference was not statistically significant (P>0.05), while IL‐4, IL‐10, IL‐17, and IL‐23 levels were significantly lower compared with before treatment (P<0.05). The results show that CO2 fractional laser treatment has a good curative effect in the treatment of vitiligo.

Doxepin is an effective therapy option in difficult‐to‐treat chronic urticaria: a retrospective, cross‐sectional study over a 20‐year period from Turkey and review of the literature
E Özkaya  G Babuna Kobaner  Z Yılmaz  A Kutlay
First published: 07 June 2019 https://doi.org/10.1111/dth.12993
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12993.
Abstract
Background
Doxepin is an old tricyclic antidepressant, whose efficacy in chronic urticaria had been well documented until 1990. However, over the past three decades, there has been limited data on its use.
Objective
To assess the efficacy and safety of doxepin in the treatment of patients with chronic urticaria who were poorly responsive to antihistamines.
Methods
In this retrospective, cross‐sectional, single‐center study from Turkey, data were examined from patients with chronic urticaria who had poor antihistamine responses and received doxepin therapy from 1998 to 2017. Patient data were analyzed with regard to the duration of the disease, age, sex, treatment outcomes using a weekly urticaria activity score (UAS7), and adverse effects of doxepin therapy. A reduction of ≥90% in UAS7 was defined as "complete response", 30‐89% as "partial response" and <30% as "no significant response".
Results
36 patients were included in this study. Doxepin was effective in a majority (n=27, 75%) of the patients with a short onset time. Sixteen patients (44.4%) showed a complete response. Mild sedative and anticholinergic side effects were well tolerated.
Conclusion
Doxepin seems to be a reasonable, efficient, and affordable alternative for the treatment of chronic urticaria in patients who respond poorly to antihistamine therapy.
Use of alitretinoin in moderate to severe chronic hand eczema: a real‐world experience in Korea
Hee Joo Kim M.D., PhD  Seul Ki Lee M.D.  Jinok Baek M.D., PhD  Joo Young Roh M.D., PhD
First published: 06 June 2019 https://doi.org/10.1111/dth.12980
Serpentine Supravenous Hyperpigmentation Related to Carboplatin and Vinorelbine Chemotherapy: A Case Report
Fatma Tunçez Akyürek  Nihal Sari  Ceyhan Uğurluoğlu  Dr Gülcan Saylam Kurtipek
First published: 06 June 2019 https://doi.org/10.1111/dth.12981
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12981.
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Abstract
Serpentine supravenous hyperpigmentation (SSH) is a unique type of chemotherapy‐associated drug eruption, characterized by hyperpigmentation along the superficial venous network. Histopathology reveals an increase in melanin production without destruction of basal cells of the epidermis or dermal inflammatory infiltrate. Herein we describe a patient who developed SSH after repeated intravenous infusions with carboplatin and vinorelbine; two medications which have been uncommonly reported in association with SHH previously.

A case of transient telangiectatic purpura after axillary dissection
Mariabeatrice Bertolani  Francesca Satolli  Alfredo Zucchi  Miriam Rovesti  Claudio Feliciani
First published: 06 June 2019 https://doi.org/10.1111/dth.12982
Mechanism of Oleogel‐S10 – a triterpene preparation for the treatment of epidermolysis bullosa
A Schwieger‐Briel  H Ott  D Kiritsi  M Laszczyk‐Lauer  C Bodemer
First published: 06 June 2019 https://doi.org/10.1111/dth.12983
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12983.
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Abstract
Epidermolysis bullosa (EB) is a group of rare heterogeneous, genetic disorders. Currently, there is no effective pharmacological or genetic therapy for all EB subtypes. Dry extract from birch bark and betulin upregulate some pro‐inflammatory mediators and downregulate others. The increase in pro‐inflammatory cytokines is temporary and attenuated over long‐term treatment. This inflammatory stimulus is thought to be prerequisite for a secondary anti‐inflammatory response. Dry extract from birch bark and its active marker substances have also been shown to increase the migration of primary human keratinocytes, accelerate wound closure, and promote differentiation of keratinocytes in vitro and in vivo – processes that are essential for re‐epithelialization and maintenance of the skin barrier. Comprehensive clinical data are available to support the use of Oleogel‐S10 in the treatment of partial thickness wounds of different aetiologies, and a proof‐of‐concept phase 2 study in patients with dystrophic EB has suggested the potential for faster re‐epithelialization of wounds treated with Oleogel‐S10.
Erythema multiforme caused by ibandronate sodium: A rare case report
Xia Song  Yinyin Guo  Hui Zhao
First published: 06 June 2019 https://doi.org/10.1111/dth.12984
Biofibre® Artificial Hair Implant : Retrospective Study on 1.518 Patients with alopecia and Present Role in Hair Surgery
F. Satolli  M. Rovesti  B. Al Bzour  G. Griselli  M. Agarwal  AAR. Said  S. Gianfaldoni  I. Lozev  I. Pidakev  C. Feliciani  G. Tchernev
First published: 06 June 2019 https://doi.org/10.1111/dth.12985
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.12985.
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ABSTRACT
To treat alopecia there are many surgical and non‐surgical treatments available nowadays. In the surgical one, the Biofibre® hair implantation system represents an important innovation with artificial hair with special physical, chemical and mechanical features and the new Biofibre® Automatic device.

Implant on 1518 patients has been reported in this study where the Biofibre® hair implant technique is performed on men and women with varying degrees of baldness and for the treatment of various causes of alopecia such as androgenetic alopecia, burns and scars.

According to our experience, this technique gives immediate and visible results without scarring or hospitalization and the aesthetic results are very encouraging for both male and female patients with a rapid recovery of self‐esteem and psychological well‐being.
Generalized verrucosis: a therapeutic challenge
Satolli Francesca MD  Gandolfi Marco MD  Rovesti Miriam MD  Zucchi Alfredo MD  Milani Massimo MD  Feliciani Claudio MD, PhD
First published: 06 June 2019 https://doi.org/10.1111/dth.12986
A Novel Halobetasol Propionate 0.01%/Tazarotene 0.045% Fixed Combination Treatment for Psoriasis
Aleksandar Radonjic BSc  Emily Evans BScH
First published: 02 June 2019 https://doi.org/10.1111/dth.12979
he elevated level of osteopontin in patients with pemphigus vulgaris: A cytokine‐like protein with a therapeutic potential
Yasaman Ketabi  Soheila Nasiri  Maedeh Kheirodin  Soheil Tavakolpour  Nikoo Mozafari
First published: 28 May 2019 https://doi.org/10.1111/dth.12973
Funding information: skin research center
Abstract
Background
Pemphigus vulgaris (PV) is a life‐threatening autoimmune disease with no certain treatment. Anticytokine therapy is being increasingly discussed in multiple autoimmune diseases. Osteopontin (OPN) is a glycoprotein produced by a variety of immune cells. Increased OPN serum levels have been reported in several autoimmune diseases, with targeting OPN considered as a promising therapy in these diseases. However, the role of OPN in PV has not been well studied so far.
Objective
To investigate whether OPN level is elevated in PV patients in the active stage of the disease and to examine its possible relationship with disease severity and anti‐desmoglein (anti‐Dsg) antibodies levels.
Materials and Methods
This study included 53 consecutive subjects affected by PV and 38 age‐ and sex‐matched healthy controls. Clinical characteristics and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) were assessed. Serum OPN levels (pg/mL) and anti‐Dsg antibodies were also measured.
Results
The serum OPN level of the patient group proved to be statistically higher than that of the control group (11.08 ± 5.24 vs 8.47 ± 5.68; p = .02). No significant relationship were detected between the serum OPN level and anti‐Dsg1 or anti‐Dsg3 antibodies (r = 0.1, p = .2 and r = 0.1, p = .4), respectively. In addition, no correlation was found between serum OPN levels and severity of PV as measured by ABSIS (r = 0.08 and p = .5).
Conclusion
The growth observed in OPN levels in pemphigus patients suggests the role of OPN in pemphigus pathogenesis, but there is a need for more extensive studies to show how OPN can be associated with the PV pathogenesis and whether OPN could be used as an important therapeutic target in pemphigus disease.

Comparative split‐face study of durational changes in hyaluronic acid fillers for mid‐face volume augmentation
Kui Y. Park  Jae M. Kim  Joon Seok  Seong J. Seo  Myeung N. Kim  Choon S. Youn
First published: 25 April 2019 https://doi.org/10.1111/dth.12950
Funding information: Merz Pharmaceuticals GmbH
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Abstract
Subsequent changes after injection should be considered when determining the precise volume of injected dermal filler. Several studies have used scoring systems to evaluate facial volumes; however, these scoring systems are not particularly objective. This present study aimed to evaluate the volumetric changes over time on three‐dimensional (3D) images and the maintenance potential of various hyaluronic acid (HA) fillers used for mid‐face volume augmentation. This split‐face clinical study included nine Korean subjects who each received a mid‐facial injection of the test filler (B) on one side and a random control filler (J, R, or Y) on the contralateral side. Global, photographic, and 3D scanning assessments were conducted at baseline and after 30 min, 3 days, and 2, 4, 12, and 24 weeks. In all nine cases, the 3D images revealed the largest differences in height where the test filler (B) was injected. The results of subjective scoring systems correlated with the results of 3D imaging. The volumes of monophasic fillers (B and J) were maintained for longer periods of time than those of biphasic fillers (R and Y). The B filler yielded excellent volumizing and spreading effects and good injectability. This filler would be suitable for injection into high‐pressure areas, such as the lateral cheek, chin, and nasolabial fold. Moreover, the 3D imaging analysis provided objective and digitized data. The present authors hope that their data will allow physicians to better understand the durational changes in HA fillers and, thus, provide accurate predictions to their patients.

Cephalosporin‐induced linear IgA dermatosis in a child: Case report and literature review
Sezgi Sarikaya Solak  Sezin Ficicioglu
First published: 12 April 2019 https://doi.org/10.1111/dth.12927
inear immunoglobulin A (IgA) dermatosis (LAD) is an autoimmune subepidermal vesiculobullous disease that may be idiopathic or drug-induced. Children and adults are affected, with disease of the former historically referred to as chronic bullous dermatosis of childhood. The clinical presentation is heterogeneous and appears similar to other blistering diseases, such as bullous pemphigoid and dermatitis herpetiformis.
 

Abstract
Linear IgA dermatosis (LAD) is a rare, subepidermal blistering disease with mucocutaneous involvement. It may be idiopathic or drug induced. We describe a 4‐year‐old girl who presented with a vesiculobullous eruption after she had been treated with cefixime for urinary tract infection. A diagnosis of drug‐induced LAD was made based on clinical, histopathological, and immunofluorescence findings. Naranjo adverse drug reaction algorithm was used to assess imputability resulting with a "probable" association. In literature, cephalosporin antibiotics are rarely reported in association with LAD. To our knowledge, this is the first case of a cefixime‐induced LAD among adults and children.
Pyoderma gangrenosum successfully treated with golimumab: Case report and review of the literature
Federico Diotallevi  Anna Campanati  Giulia Radi  Valerio Brisigotti  Elisa Molinelli  Donatella Brancorsini  Annamaria Offidani
First published: 12 April 2019 https://doi.org/10.1111/dth.12928
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Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis frequently related to chronic inflammatory bowel disease (IBD) often associated with exacerbation of intestinal disease and/or loss of treatment efficacy. However, in patients with comorbidities, such as diabetes, the diagnosis may be a challenge. Here, we report the case of a 68‐year‐old man with a history of ulcerative rectocolitis (URC), type II diabetes and arterial hypertension, who had been treated with infliximab and adalimumab in the past. In September 2017, patient developed an erythematous, infiltrated and painful lesion of the third distal part of his left leg, with ulcerative evolution, rapidly worsened despite a broad‐spectrum antibiotic treatment had been introducted. A worsening of rectocolitis occurred simultaneously. In agreement with the gastroenterologists, patient started a new biological therapy with golimumab, and oral prednisone with slow tapering of steroid dosage following the improvement of both cutaneous and intestinal symptoms. Dermatologists should be aware about the risk of PG in patient suffering from IBDs, and consider this diagnosis in all patients affected by URC developing rapidly extending ulcerative skin lesion. Moreover, therapeutic choice should take into consideration the effectiveness of golimumab on the inflammatory background, which sustains both intestinal and skin disease in this type of patients.
Occupational contact dermatitis caused by opioids: A case series
Ursula Flury  Jennifer L. Cahill  Rosemary L. Nixon
First published: 08 May 2019 https://doi.org/10.1111/cod.13305
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Abstract
Background
Opioid‐manufacturing facility workers are at risk of developing occupational contact dermatitis.

Objectives
To describe the causes of occupational allergic contact dermatitis caused by opioids in an opioid‐manufacturing facility.

Materials and Methods
A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne, Australia from 2004 to 2017.

Results
Fifteen workers from an opioid‐manufacturing facility were assessed in our clinic over a period of 14 years. Of these, 11 individuals were diagnosed with occupational allergic contact dermatitis caused by opioids, with seven reacting to thebaine, five to morphine, four to norhydroxymorphinone, two to codeine, and two to oripavine. Two people were suspected of having immediate hypersensitivity reactions to opioids, including one who also had allergic contact dermatitis. Two patients were diagnosed with urticaria, aggravated at work. One patient was diagnosed with a non‐occupational rash.

Conclusions
We report a case series of workers with allergic contact dermatitis caused by opioids in a manufacturing facility. With greater awareness, including implementation of an educational programme and improved skin protection, the number of cases declined over time. Interestingly, norhydroxymorphinone had not been reported as an allergen before. Further testing is required to establish optimal patch test concentrations of all opiates.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com